Advanced decision template

I, [NAME] of [ADDRESS] being a person not lacking capacity within the terms of section 2 (1) of the Mental Capacity Act 2005 (“the Act”) hereby make in writing and in the presence of a witness this advance decision pursuant to section 25 of the Act.

My advance decision is as follows.

If I should fall into a permanent vegetative state or a minimally conscious state, then artificial nutrition and hydration should be withdrawn without any delay with the objective that I should die as quickly as possible. For the avoidance of any doubt, I declare pursuant to section 25(5)(a) of the Act that I recognise my advance decision will place my life at risk.

I do not wish this decision to be the subject of any kind of review by the Court of Protection.

Signed

Date

WITNESSED BY: Signed

Name

Address

Date